Effect of uphill treadmill exercise on standard therapy to hamstrings tightness in patients with knee osteoarthritis at Dr. Soetomo General Hospital Surabaya
DOI:
https://doi.org/10.47197/retos.v68.115899Keywords:
Hamstring tightness, Osteoarthritis, Knee, Treadmill, ActivityAbstract
Introduction: Knee osteoarthritis causes excessive muscle contraction during walking, increased muscle tension in patients accompanied by changes in muscle stiffness related to hamstring tightness. Straight Leg Raise (SLR) is a measurement used to assess hamstring tightness using a gravity inclinometer.
Objective: To evaluate the effect of uphill treadmill exercise as an addition to standard therapy on hamstrings tightness in patients with grade II-III knee osteoarthritis at Dr. Soetomo General Hospital Surabaya.
Methodology: The control group received standard therapy (TENS and Q-bench) while the treatment group received standard therapy plus uphill treadmill exercise (8-degree inclination, speed 1.1 m/s, 30 minutes, 2x/week, for 5 weeks). Hamstring tightness was evaluated using SLR with a gravity inclinometer at three points: pre-intervention, post-intervention, and 20 days after the final exercise.
Results: The treatment group's value compared to the control group in early-late right ΔHT (p=0.029; Cohen's D=0.78) and early-late left P ΔHT (p=0.02; Cohen's D=1.12).
Discussion: Uphill treadmill exercise added to standard therapy significantly improved hamstring tightness in both legs with moderate to large effect sizes. The eccentric contractions during inclined walking likely contributed to reduced muscle tension and improved flexibility.
Conclusions: Additional uphill treadmill exercise produced meaningful changes in hamstring tightness in both legs for patients with grade II-III knee OA compared to standard therapy alone.
References
Alshami, A. M., & Alhassany, H. A. (2020). Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case–control study. Journal of Taibah University Medical Sciences, 15(3), 197–202. https://doi.org/10.1016/j.jtumed.2020.04.002
Anjum, N., Sheikh, R. K., Omer, A., Anwar, K., Khan, M. M. H., Aftab, A., & Awan, W. A. (2023). Comparison of instrument-assisted soft tissue mobilization and proprioceptive neuromuscular stretching on hamstring flexibility in patients with knee osteoarthritis. PeerJ, 11, e16506. https://doi.org/10.7717/peerj.16506
Cai, L., Shi, L., Peng, Z., Sun, Y., & Chen, J. (2023). Ageing of skeletal muscle extracellular matrix and mitochondria: finding a potential link. Annals of Medicine, 55(2). https://doi.org/10.1080/07853890.2023.2240707
Chen, L., Zheng, J. J. Y., Li, G., Yuan, J., Ebert, J. R., Li, H., Papadimitriou, J., Wang, Q., Wood, D., Jones, C. W., & Zheng, M. (2020). Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. Journal of Orthopaedic Translation, 24, 66–75. https://doi.org/10.1016/j.jot.2020.05.001
Christina, M., Puspitasari, W., & Kartika, S. E. (2023). The Effect Of Leg Muscle Strength Exercise On The Intensity Of Prelansian And Elderly Knee Pain In The Village Of Pandean Lamper, Semarang under a Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC 4.0). Jurnal Eduhealth, 14(02), 2023. http://ejournal.seaninstitute.or.id/index.php/healt
Erol, E., & Bulut, B. N. (2024). Acute effect of instrument-assisted soft tissue mobilization on hamstring flexibility via fascial chain. BMC Musculoskeletal Disorders, 25(1), 1046. https://doi.org/10.1186/s12891-024-08182-7
Gulrandhe, P., Yadav, V., & Naqvi, W. M. (2023). Correlation Between Foot Posture and Hamstring Muscle Tightness. Cureus. https://doi.org/10.7759/cureus.42046
Henin, G., Loumaye, A., Leclercq, I. A., & Lanthier, N. (2024). Myosteatosis: Diagnosis, pathophysiology and consequences in metabolic dysfunction-associated steatotic liver disease. JHEP Reports, 6(2), 100963. https://doi.org/10.1016/j.jhepr.2023.100963
Jiang, L., Qu, F., Yang, Z., Chen, X., Gao, X., Sun, Q., & Huo, B. (2024). Heel-to-toe drop effects on biomechanical and muscle synergy responses during uphill walking. Frontiers in Bioengineering and Biotechnology, 12. https://doi.org/10.3389/fbioe.2024.1385264
Joshi, S., & Singh Yadav, V. (2019). Knee Joint Muscle Flexibility in Knee Osteoarthritis Patients and Healthy Individuals. International Journal of Health Sciences & Research (Www.Ijhsr.Org), 9(6), 156. www.ijhsr.org
Kalkhoven, J. T., Lukauskis-Carvajal, M., Sides, D. L., McLean, B. D., & Watsford, M. L. (2023). A Conceptual Exploration of Hamstring Muscle–Tendon Functioning during the Late-Swing Phase of Sprinting: The Importance of Evidence-Based Hamstring Training Frameworks. Sports Medicine, 53(12), 2321–2346. https://doi.org/10.1007/s40279-023-01904-2
Kellis, E., & Blazevich, A. J. (2022). Hamstrings force-length relationships and their implications for angle-specific joint torques: a narrative review. BMC Sports Science, Medicine and Rehabilitation, 14(1), 166. https://doi.org/10.1186/s13102-022-00555-6
Kus, G., & Yeldan, I. (2019). Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis. Rheumatology International, 39(2), 203–218. https://doi.org/10.1007/s00296-018-4199-6
Lee, J. H., Jang, K.-M., Kim, E., Rhim, H. C., & Kim, H.-D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports Health: A Multidisciplinary Approach, 13(1), 49–56. https://doi.org/10.1177/1941738120932911
Li, F., Wang, Z.-Y., Zhang, Z.-J., Shen, S.-H., Guo, J.-Y., Guo, Y.-X., Feng, Y.-R., Zhang, L., Wen, Y.-B., Zhang, Y.-F., Fan, Y.-M., & Fan, M.-M. (2022). In Hamstring Muscles of Patients With Knee Osteoarthritis an Increased Ultrasound Shear Modulus Indicates a Permanently Elevated Muscle Tonus. Frontiers in Physiology, 12. https://doi.org/10.3389/fphys.2021.752455
Lima, C. D., Brown, L. E., Li, Y., Herat, N., & Behm, D. (2019). Periodized versus Non-periodized Stretch Training on Gymnasts Flexibility and Performance. International Journal of Sports Medicine, 40(12), 779–788. https://doi.org/10.1055/a-0942-7571
Liyanage, E., Krasilshchikov, O., Hashim, H. A., & Jawis, N. M. (2020). Prevalence of hamstring tightness and hamstring flexibility of 9-11 years old children of different obesity and physical activity levels in Malaysia and Sri Lanka. Journal of Physical Education and Sport, 20, 338–343. https://doi.org/10.7752/jpes.2020.s1047
Lopes, H. S., Waiteman, M. C., Priore, L. B., Glaviano, N. R., Bazett-Jones, D. M., Briani, R. V., & Azevedo, F. M. (2024). There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. Journal of Sport and Health Science, 13(4), 521–536. https://doi.org/10.1016/j.jshs.2023.08.004
Luan, L., El-Ansary, D., Adams, R., Wu, S., & Han, J. (2022). Knee osteoarthritis pain and stretching exercises: a systematic review and meta-analysis. Physiotherapy, 114, 16–29. https://doi.org/10.1016/j.physio.2021.10.001
Mahant, Dr. M., & Shukla, Dr. Y. (2021). Correlation between hamstring tightness and time duration of disease in knee osteoarthritis: an observational cross-sectional study. VIMS JOURNAL OF PHYSICAL THERAPY, 3(2), 89–92. https://doi.org/10.46858/VIMSJPT.3206
Mata Diz, J. B., de Souza, J. R. L. M., Leopoldino, A. A. O., & Oliveira, V. C. (2017). Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review. Journal of Physiotherapy, 63(1), 17–22. https://doi.org/10.1016/j.jphys.2016.11.008
Mi, B., Xiong, Y., Knoedler, S., Alfertshofer, M., Panayi, A. C., Wang, H., Lin, S., Li, G., & Liu, G. (2024). Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system. Bone Research, 12(1), 42. https://doi.org/10.1038/s41413-024-00346-4
Miyamoto, N., Hirata, K., Kimura, N., & Miyamoto-Mikami, E. (2018). Contributions of Hamstring Stiffness to Straight-Leg-Raise and Sit-and-Reach Test Scores. International Journal of Sports Medicine, 39(02), 110–114. https://doi.org/10.1055/s-0043-117411
Pacifico, D., Visscher, R., List, R., Item-Glatthorn, J. F., Casartelli, N. C., & Maffiuletti, N. A. (2020). Discriminant validity and reproducibility of spatiotemporal and kinetic parameters during treadmill walking in patients with knee osteoarthritis. Gait & Posture, 80, 77–79. https://doi.org/10.1016/j.gaitpost.2020.04.002
Pesonen, J., Shacklock, M., Rantanen, P., Mäki, J., Karttunen, L., Kankaanpää, M., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion. BMC Musculoskeletal Disorders, 22(1), 303. https://doi.org/10.1186/s12891-021-04159-y
Raghava Neelapala, Y. V., Bhagat, M., & Shah, P. (2020). Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. Journal of Geriatric Physical Therapy, 43(2), 89–98. https://doi.org/10.1519/JPT.0000000000000214
Reichenbach, S., Jüni, P., Hincapié, C. A., Schneider, C., Meli, D. N., Schürch, R., Streit, S., Lucas, C., Mebes, C., Rutjes, A. W. S., & da Costa, B. R. (2022). Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis and Cartilage, 30(3), 426–435. https://doi.org/10.1016/j.joca.2021.10.015
Sailor, S., Limbani, A., & Dhola, D. (2020). Association between Hamstring Flexibility and Functional Performance of Patients with Knee Osteoarthritis. Journal of Integrated Health Sciences, 8(2), 57. https://doi.org/10.4103/JIHS.JIHS_28_20
Sedaghatnezhad, P., Shams, M., Karimi, N., & Rahnama, L. (2021). Uphill treadmill walking plus physical therapy versus physical therapy alone in the management of individuals with knee osteoarthritis: a randomized clinical trial. Disability and Rehabilitation, 43(18), 2541–2549. https://doi.org/10.1080/09638288.2019.1703146
Sharma, L. (2021). Osteoarthritis of the Knee. New England Journal of Medicine, 384(1), 51–59. https://doi.org/10.1056/NEJMcp1903768
Sherazi, F., Waqar, S., Khalid, M., Saleem, K., Kiani, S. K., & Shahzad, M. (2022). Effect of Knee Joint Mobilization on Hamstring Muscle Length in Patient with Knee Osteoarthritis. The Rehabilitation Journal, 06(04), 468–473. https://doi.org/10.52567/trj.v6i04.189
Shumnalieva, R., Kotov, G., & Monov, S. (2023). Obesity-Related Knee Osteoarthritis—Current Concepts. Life, 13(8), 1650. https://doi.org/10.3390/life13081650
Tschon, M., Contartese, D., Pagani, S., Borsari, V., & Fini, M. (2021). Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data. Journal of Clinical Medicine, 10(14), 3178. https://doi.org/10.3390/jcm10143178
Tuna, S., Çelik, B., & Balcı, N. (2022). The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation, 35(2), 341–346. https://doi.org/10.3233/BMR-200287
Vincent, H. K., Madsen, A., & Vincent, K. R. (2022). Role of Antigravity Training in Rehabilitation and Return to Sport After Running Injuries. Arthroscopy, Sports Medicine, and Rehabilitation, 4(1), e141–e149. https://doi.org/10.1016/j.asmr.2021.09.031
Wang, L., Valencak, T. G., & Shan, T. (2024). Fat infiltration in skeletal muscle: Influential triggers and regulatory mechanism. IScience, 27(3), 109221. https://doi.org/10.1016/j.isci.2024.109221
Yoshida, T., Tanino, Y., Nakao, T., Yamazaki, W., & Suzuki, T. (2024). Change in Achilles Tendon Length after Walking on Treadmill with Gradient. Progress in Rehabilitation Medicine, 9(0), 20240006. https://doi.org/10.2490/prm.20240006
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Taurisia Kristiani, Damayanti Tinduh, I Putu Alit Pawana, Soenarnatalina Melaniani
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
